WCE 2017: Robotic, Laparoscopic, and Open Approaches in Radical Prostatectomy Effect on Mortality, Readmission, and Length of Stay

Vancouver, Canada (UroToday.com) Population-based studies provide clinical insight and (most often) validation of cancer control and functional outcomes for patients undergoing radical prostatectomy for the treatment of prostate cancer. While there have been numerous studies using previous population databases, early robotic era studies comparing robotic (RARP), laparoscopic (LRP) and open (ORP) radical prostatectomy series may no longer describe contemporary patients. 

Mr. Mark Finkelstein (BS), a medical student from Icahn School of Medicine at Mount Sinai presents a retrospective study on the New York Statewide Planning and Research Cooperative System (SPRC) queried for cases from 2009-2015. Because the modifier for robotic versus laparoscopic RP was introduced in October 2008, this dataset represents the most contemporary study analyzing complication rate, hospital stay length, and perioperative demographics in comparison between RARP, LRP, and ORP series. 

18, 705, 589, and 8,635 robotic, laparoscopic and open radical prostatectomies were included, respectively. The primary outcome measure was 30- and 90-day readmission rates, 1-year overall mortality, and hospital stays >12 days. High volume urologists and institutions were identified such that each accounted for 25% of all cases performed, while multivariate analysis also included surgeon experience, hospital affiliation, and hospital setting, procedure year, and surgeon time from medical school gradation as covariates. 

Since 2009, the frequency of open and laparoscopic RP has continuously decreased in favor of the RARP. Overall, RARP was associated with decreased 1-year mortality (OR 0.548) and decreased prolonged length of stay (OR 0.400) over the open approach. Conversely, LRP was associated with decreased prolonged length of stay (OR 0.307). Readmission rate was not found to statistically significant in either comparison. Interestingly, however, volume of surgeries performed by the urologist was associated with a 0.5% decrease in one-year mortality for every 10 cases per year (OR 0.995) and 2.5% decrease in length of stay (OR 0.972). 

As a contemporary series comparing RARP, LRP, and ORP, this population-based study shows a clear advantage in favor of the RARP in one-year overall mortality and length of hospital stays. While the LRP was also found to be beneficial in lowering the length of stay, there was no advantage in 30- or 90-day readmission or one-year mortality. Further validation in national cancer registries and databases are required to confirm these findings. 

Presented by: Mark Finkelstein

Authors: Mark Finkelstein, Khawaja Bilal, BSc, MD , Michael Palese
Affiliation: Icahn School of Medicine at Mount Sinai New York, New York

Written by: Linda Huynh (BS), assistant research specialist, University of California, Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.